Seller's Investment in Life Insurance Contract

• Legal Form Number: 1099-SB
• Year: 2025
• Issuer: Treasury Department
• Section: Treasury Department

Form 1099-SB

(Rev. December 2019)

Cat. No. 71384X

Seller’s Investment in

Life Insurance

Contract

Copy A

For

Internal Revenue

Service Center

Department of the Treasury - Internal Revenue Service

File with Form 1096.

OMB No. 1545-2281

For Privacy Act

and Paperwork

Reduction Act

Notice, see the

current General

Instructions for

Certain

Information

Returns.

4343

For calendar year

20

VOID CORRECTED

ISSUER’S name, street address, city or town, state or province, country, ZIP

or foreign postal code, and telephone no.

ISSUER’S TIN SELLER’S TIN

SELLER’S name

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code

Policy number

1 Investment in contract

$

2 Surrender amount

$

Issuer’s information contact name, street address, city or

town, state or province, country, ZIP or foreign postal code,

and telephone no. (if different from ISSUER)

Form 1099-SB (Rev. 12-2019) www.irs.gov/Form1099SB

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